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Many of our patients have dental insurance that is either provided by their employer, or one that they purchase for themselves. There is much confusion and misunderstanding when it comes to dental insurance and the benefits that are actually provided. Even in an office our size, we have hundreds of different dental insurance plans that we work with daily.
Insurance providers can have multiple plans that each provide different coverage, so your coverage is dependent on what plan you or your employer chose when signing up. What makes this difficult is that the dental insurance company is unable to provide health care providers with exact amounts and detailed information which would enable us to provide better service to our patients.
We do our very best to help assist you by giving you an estimation of expected dental benefits based off of the information we are given and our years of experience with insurance companies. Typically the estimations we give our patients are fairly accurate, even with limited assistance from the dental insurance company. As a benefit and service for our patients we only ask that our patients pay their estimated portion (co-pay) at the time of service. We will submit most of your dental claims electronically to ensure the fastest time of reimbursement.
If you have dental insurance, we try our very best to assist you in maximizing your benefits so as to help you get the dental care that is recommended. However, we hope that you don’t allow the dental insurance company to dictate your decision on recommended dental treatment.
Over the nearly 30 years in dentistry, we have seen the influence of dental insurance dramatically increase when it comes to healthcare. Too many times we see patients base their decision to move forward with recommended dental treatment on whether or not their insurance company will cover it. Remember, in most cases the dental insurance company makes their determination without examining you, and in most cases, it is NOT even made by a dentist.
The first dental insurance plans were started in the late 1950’s. At the time, most dental practices were totally Fee for Service (cash) and they did not take or work with dental insurances. However, the interesting thing to take from the early dental insurance was that the average annual maximum benefit provided was $1000. Sound familiar? It should, because that is still the most commonly found annual maximum benefit found even today in 2015.
What is the significance of that amount? If you would just minimally adjust the $1000 for inflation since 1955, the annual maximum benefit today would be $8829.00. This amount would much better represent a fair amount that could provide coverage for an adult patient. The $1000 annual maximum of today does not provide much dental benefits other than a few cleanings and some minor dental procedures. If you require any major dental services, crowns, bridges or root canals, you will easily exceed the annual maximum benefit established in one dental visit.
That is the reason behind why we offer various forms of financing in our office to help facilitate the little reimbursement from the insurance company.
Some misconceptions we frequently hear from our patients is that our fees are too high according to their dental insurance company. Patients often comment that the information they received back from their insurance company states we exceeded the allowable UCR fee (Usual Customary Reasonable). What the dental insurance doesn’t explain is that their UCR is unique to them, and the dental insurance company establishes their own UCR fee schedule which varies considerably. It is not representative of what the individual dentists charge, or an average of all of the dentists in a particular area. It is solely based on the dental insurance company, and does not reflect the American Dental Associations (ADA) calculation of average fees for dental procedures based on regions.
It is common for dental practices to do an adjustment of 20%-40% of their normal dental fees when they are Providers for a dental insurance company. These are the same fees that patients without dental insurance will pay in dental offices. Some patients mistakenly think this adjustment is made because of an excessive fee charged by the dentist.
Recently we have started to see a number of troubling new dental insurance “policies” with our patients that severely limit reimbursement from their insurance company. One of the most common policies we are seeing is a 1 year waiting period on ALL major dental procedures. This means that even though you currently have dental insurance and are eligible for benefits, they will only cover a few dental cleanings and some minor dental procedures for the first year of the plan.
Another limitation we are finding is a Missing Tooth Clause. This means if you have had the misfortune to have lost a tooth prior to obtaining your current dental insurance, they will not cover any replacement at all, meaning if you have an existing replacement that is failing and needs to be replaced your dental plan will never cover the cost. So hopefully you have all of your teeth when you purchase or become eligible for new dental insurance plan.
To add even more ways the dental insurance company can deny payment for a dental service that is needed and recommended, we are seeing a 10 year limitation on replacing failing crowns. For years, the limitation on replacing failing old crowns was 5 years. It is becoming the norm, that many insurance companies are extending this limitation to 10 years. As a healthcare provider, I view this as a way to provide fewer benefits for you, and can directly affect your overall dental health.
We don’t want to imply dental insurance as being a negative thing, but we are frustrated and concerned that not only in our dental health, but also our medical well-being the insurance companies are the ones that are now dictating the type of care we receive.
Do we believe there is some good news when it comes to dental insurance? Absolutely! Studies have shown that there is a direct correlation between the establishment of dental insurance and increased awareness about the importance of preventative dental visits to maintain their overall health.
Dental insurances have encouraged patients to visit dental offices at least twice a year for cleanings and exams. This has lead to a dramatic decrease in tooth loss due to periodontal disease and decay. Today, we expect our patients to keep all of their teeth for the rest of their lives. This was not the case in 1950 when tooth loss and dentures were in a person’s future as they aged. Today, we remind our patients that even though the insurance companies are reimbursing at a much lower rate than they would like, it is a nice assistance in helping to enable them to complete the dentistry that they need. This makes dental care more affordable and we find patients are willing to address necessary dental issues.
Dental insurance is here to stay, and will always be something that is considered when patients select their dentist or decide on recommended treatment. We spend plenty of time assisting our patients in understanding their particular dental insurance, and reviewing their dental needs. Our only hope is that patients don’t allow the dental insurance company to place a wedge in the very important patient doctor relationship. We at Drs. Chin & Pharar Dentistry are available to assist you in maximizing your dental benefits.